Boo-boo kissing study has ethicists and others up in arms

Were 943 Ottawa toddlers really given “experimentally induced minor injuries” in the name of science and the study of boo-boo kissing?

Well, no, but you could be forgiven for thinking so. In fact a number of online news outlets reported last week that boo-boo kissing by mothers does not work, apparently missing the fact that a somewhat disturbing study purporting to have been conducted in Ottawa was invented and an article about it in a respected scientific journal was satire.

In the study, children between the ages of 18 and 36 months were given minor injuries “in order to best simulate the types of injuries most often occurring in toddlers.”

Children were allowed to crawl under a low table for a piece of chocolate, said the article. “Invariably, the child would then stand to eat the chocolate and would strike his or her head on the table edge.”

Other children received minor boo-boos after reaching over a heating coil to get a favourite object, according to the study. “Each child was subjected to only one boo-boo during testing session.”

Some injured toddlers were then kissed, but they could not see whether it was by their mother or someone else. Some children were not kissed. According to the study, their resulting discomfort was scored on a Toddler Discomfort Index.

The sham study called “Maternal kisses are not effective in alleviating minor childhood injuries (boo-boos): a randomized controlled and blinded study” concluded by calling for “a moratorium on the practice.”

The publication of what its author and editor say was medical satire has left some ethicists demanding an apology from the journal and some parents scratching their heads. Others said they thought it was a hoax on the journal to test whether its peer-review system was legitimate.

But the journal’s editor and the study’s author say the article was obviously satire, is part of a tradition of medical satire in scientific journals (especially around Christmas), and serves a valuable purpose, notably to underscore the limitations and pitfalls of clinical research.

“The Journal for Evaluation in Clinical Practice has always believed that satire assists science and medicine, but in small and appropriate doses,” wrote its editor in chief Andrew Miles in an email.

Author Mark Tonelli, a professor of Intensive Care Medicine and Bioethics at the University of Washington, Seattle, and a bioethicist, said there were plenty of clues in the article that it was satire (it was said to have been conducted by the Study of Maternal and Child Kissing SMACK working group and funded by a company called Proctor and Johnson Inc.).

“The work was never designed to deceive anybody,” Tonelli said. He said it was meant to underline some of the weaknesses of clinical research as well as the corrosive influence of industry on scientific research.

“I view this as an educational piece. I think we will ultimately see whether or not it has the effect that both the journal editor and myself hoped it would have, that it would stimulate conversation among health care practitioners about some of these issues. It is too early to say whether it is going to do that.”

But Jack Marshall, a Washington, D.C., lawyer and professional ethicist, said the study not only needed a disclaimer to make it clear it was not real, but the journal’s failure to do so demonstrates “the inherent arrogance of scientists.

“He should apologize,” Marshall said of the journal’s editor. “He fooled people, people who trusted him and were misled.”

And Matthew McLennan, assistant professor of public ethics at St. Paul University in Ottawa, said the article has the potential to erode public confidence in the journal.

“The Internet is already a source of confusion. I would expect a scholarly journal to not contribute to the confusion.”

Several online news organizations reprinted details of the study as if is was legitimate. A website called The Daily Caller ran a headline calling it the dumbest study ever. “A study out of Ottawa, Canada, has confirmed what people have known for years: mothers kissing minor scrapes and cuts does not, in fact, make them better.”

It later updated the story saying the study was a hoax.

The original Daily Caller story concluded with this line: “Mercifully, as the study is Canadian, it is highly unlikely US taxpayers footed the bill for it.”

Tonelli said he chose Ottawa as the location for the fake study randomly. He initially thought about setting it in Hamilton, because McMaster University is often seen as a centre of evidence-based medicine, a focus of the research and the journal. But he thought that was too obvious, “so I went a little bit north east.”

“I have nothing against Ottawa. I am sorry, I hope I am not in trouble.”

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